FPIN's Clinical Inquiries

Clinical Inquiries from the Family Practice Inquiries Network (FPIN) provide short, concise, evidence-based answers to clinical questions common in family medicine. The answers include a summary of the evidence and commentary that puts the answers into perspective.

Aug 1, 2005 Issue
Treatment of Early Parkinson's Disease
Treatment of early Parkinson’s disease with either selegiline (Eldepryl), a dopamine agonist (pramipexole [Mirapex], ropinirole [Requip], or bromocriptine [Parlodel]), or the combination of levodopa and carbidopa (Sinemet) or levodopa and cabidopa with entacapone (Stalevo) improves symptoms and quality of life, but all medication regimens are associated with significant side effects. There is no compelling evidence favoring a medication option, so treatment should be individualized.

Jul 1, 2005 Issue
Raloxifene for Prevention of Osteoporotic Fractures
Raloxifene (60 mg daily for three years) will prevent one vertebral fracture, including asymptomatic fractures, for every 46 postmenopausal women with osteoporosis or presence of previous vertebral fractures. Raloxifene has not been shown to prevent nonvertebral fractures. It is unclear if longer duration of treatment is warranted, or whether this risk reduction is sustained after discontinuation of treatment.

Jun 1, 2005 Issue
Treatment of Calf Deep Venous Thrombosis
Patients with a first episode of calf DVT with a transient risk factor should receive heparin therapy followed by oral anticoagulation for six to 12 weeks.

May 1, 2005 Issue
Management of Subclinical Hypothyroidism
Treatment of subclinical hypothyroidism with levothyroxine may be of most benefit to patients with symptoms suggestive of hypothyroidism and those patients with thyroid-stimulating hormone (TSH) levels higher than 10 μIU per mL (10 mIU per L) or positive anti-thyroid peroxidase (TPO) antibodies. Levothyroxine is recommended for pregnant patients. For asymptomatic patients with TSH levels between 4.5 and 10 μIU per mL (4.5 and 10 mIU per L), treatment may not be beneficial, but their thyroid function should be monitored at six- to 12-month intervals.

Apr 1, 2005 Issue
St. John's Wort for Depression
St. John’s wort is safe and effective for short-term (six to eight weeks) relief of mild to moderate depression in adults.

Mar 1, 2005 Issue
Colorectal Cancer Screening
Both FOBT and flexible sigmoidoscopy are effective in screening for colorectal cancer. FOBT can reduce mortality from colorectal cancer.

Feb 1, 2005 Issue
Treatments for Persistent Otitis Media with Effusion
Treatments such as antibiotics, steroids, antihistamines/decongestants, and mucolytics afford no long-term benefit in the treatment of patients with otitis media with effusion (OME).

Jan 1, 2005 Issue
Intravenous Fluids for Children with Gastroenteritis
Most children with gastroenteritis do not require intravenous fluids and will respond favorably to ORT. Intravenous fluids do not shorten the duration of gastroenteritis and are more likely to cause adverse effects than ORT.

Dec 1, 2004 Issue
Antidepressant Medications in Pregnancy
Selective serotonin reuptake inhibitors (SSRIs) are considered first-line agents for the treatment of depression in pregnant women. SSRIs and tricyclic antidepressants (TCAs) are considered safe and effective in pregnant women, although some studies have indicated increased short-term neonatal adverse effects after exposure to antidepressants in the third trimester.

Nov 1, 2004 Issue
Screening Mammography in Women 40 to 49 Years of Age
While there is strong agreement among experts and evidence in the literature to recommend that women 50 to 69 years of age undergo screening with mammography for breast cancer, the question of screening women 40 to 49 years of age is controversial. The results of most studies suggest that screening with mammography in women 40 to 49 years of age may reduce mortality from breast cancer, but these reductions are small (i.e., fewer than 1 in 10,000 per year).

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